Provider Demographics
NPI:1396966933
Name:AVALON CHIROPRACTIC P.C.
Entity type:Organization
Organization Name:AVALON CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HETTINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-275-7977
Mailing Address - Street 1:1480 W CATALPA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1212
Mailing Address - Country:US
Mailing Address - Phone:773-275-7977
Mailing Address - Fax:773-275-7978
Practice Address - Street 1:1480 W CATALPA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1212
Practice Address - Country:US
Practice Address - Phone:773-275-7977
Practice Address - Fax:773-275-7978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009186261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)